Full Text of HB0011 98th General Assembly
HB0011sam001 98TH GENERAL ASSEMBLY | Sen. Jacqueline Y. Collins Filed: 5/8/2013
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| 1 | | AMENDMENT TO HOUSE BILL 11
| 2 | | AMENDMENT NO. ______. Amend House Bill 11 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Nursing Home Care Act is amended by | 5 | | changing Section 3-202.05 as follows: | 6 | | (210 ILCS 45/3-202.05) | 7 | | Sec. 3-202.05. Staffing ratios effective July 1, 2010 and | 8 | | thereafter. | 9 | | (a) For the purpose of computing staff to resident ratios, | 10 | | direct care staff shall include: | 11 | | (1) registered nurses; | 12 | | (2) licensed practical nurses; | 13 | | (3) certified nurse assistants; | 14 | | (4) psychiatric services rehabilitation aides; | 15 | | (5) rehabilitation and therapy aides; | 16 | | (6) psychiatric services rehabilitation coordinators; |
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| 1 | | (7) assistant directors of nursing; | 2 | | (8) 50% of the Director of Nurses' time; and | 3 | | (9) 30% of the Social Services Directors' time. | 4 | | The Department shall, by rule, allow certain facilities | 5 | | subject to 77 Ill. Admin. Code 300.4000 and following (Subpart | 6 | | S) to utilize specialized clinical staff, as defined in rules, | 7 | | to count towards the staffing ratios. | 8 | | Within 120 days of the effective date of this amendatory | 9 | | Act of the 97th General Assembly, the Department shall | 10 | | promulgate rules specific to the staffing requirements for | 11 | | facilities federally defined as Institutions for Mental | 12 | | Disease. These rules shall recognize the unique nature of | 13 | | individuals with chronic mental health conditions, shall | 14 | | include minimum requirements for specialized clinical staff, | 15 | | including clinical social workers, psychiatrists, | 16 | | psychologists, and direct care staff set forth in paragraphs | 17 | | (4) through (6) and any other specialized staff which may be | 18 | | utilized and deemed necessary to count toward staffing ratios. | 19 | | Within 120 days of the effective date of this amendatory | 20 | | Act of the 97th General Assembly, the Department shall | 21 | | promulgate rules specific to the staffing requirements for | 22 | | facilities licensed under the Specialized Mental Health | 23 | | Rehabilitation Act. These rules shall recognize the unique | 24 | | nature of individuals with chronic mental health conditions, | 25 | | shall include minimum requirements for specialized clinical | 26 | | staff, including clinical social workers, psychiatrists, |
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| 1 | | psychologists, and direct care staff set forth in paragraphs | 2 | | (4) through (6) and any other specialized staff which may be | 3 | | utilized and deemed necessary to count toward staffing ratios. | 4 | | (b) Beginning January 1, 2011, and thereafter, light | 5 | | intermediate care shall be staffed at the same staffing ratio | 6 | | as intermediate care. | 7 | | (c) Facilities shall notify the Department within 60 days | 8 | | after the effective date of this amendatory Act of the 96th | 9 | | General Assembly, in a form and manner prescribed by the | 10 | | Department, of the staffing ratios in effect on the effective | 11 | | date of this amendatory Act of the 96th General Assembly for | 12 | | both intermediate and skilled care and the number of residents | 13 | | receiving each level of care. | 14 | | (d)(1) Effective July 1, 2010, for each resident needing | 15 | | skilled care, a minimum staffing ratio of 2.5 hours of nursing | 16 | | and personal care each day must be provided; for each resident | 17 | | needing intermediate care, 1.7 hours of nursing and personal | 18 | | care each day must be provided. | 19 | | (2) Effective January 1, 2011, the minimum staffing ratios | 20 | | shall be increased to 2.7 hours of nursing and personal care | 21 | | each day for a resident needing skilled care and 1.9 hours of | 22 | | nursing and personal care each day for a resident needing | 23 | | intermediate care. | 24 | | (3) Effective January 1, 2012, the minimum staffing ratios | 25 | | shall be increased to 3.0 hours of nursing and personal care | 26 | | each day for a resident needing skilled care and 2.1 hours of |
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| 1 | | nursing and personal care each day for a resident needing | 2 | | intermediate care. | 3 | | (4) Effective January 1, 2013, the minimum staffing ratios | 4 | | shall be increased to 3.4 hours of nursing and personal care | 5 | | each day for a resident needing skilled care and 2.3 hours of | 6 | | nursing and personal care each day for a resident needing | 7 | | intermediate care. | 8 | | (5) Effective January 1, 2014, the minimum staffing ratios | 9 | | shall be increased to 3.8 hours of nursing and personal care | 10 | | each day for a resident needing skilled care and 2.5 hours of | 11 | | nursing and personal care each day for a resident needing | 12 | | intermediate care.
| 13 | | (e) Ninety days after the effective date of this amendatory | 14 | | Act of the 97th General Assembly, a minimum of 25% of nursing | 15 | | and personal care time shall be provided by licensed nurses, | 16 | | with at least 10% of nursing and personal care time provided by | 17 | | registered nurses. These minimum requirements shall remain in | 18 | | effect until an acuity based registered nurse requirement is | 19 | | promulgated by rule concurrent with the adoption of the | 20 | | Resource Utilization Group classification-based payment | 21 | | methodology, as provided in Section 5-5.2 of the Illinois | 22 | | Public Aid Code. Registered nurses and licensed practical | 23 | | nurses employed by a facility in excess of these requirements | 24 | | may be used to satisfy the remaining 75% of the nursing and | 25 | | personal care time requirements. Notwithstanding this | 26 | | subsection, no staffing requirement in statute in effect on the |
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| 1 | | effective date of this amendatory Act of the 97th General | 2 | | Assembly shall be reduced on account of this subsection. Both | 3 | | the 25% licensed nurse requirement and 10% registered nurse | 4 | | requirement shall remain in effect until an acuity based | 5 | | licensed nurse requirement and registered nurse requirement | 6 | | are adopted in administrative rules subsequent to the | 7 | | implementation of the Resource Utilization Group | 8 | | classification-based payment methodology, as provided in | 9 | | Section 5-5.2 of the Illinois Public Aid Code. An acuity based | 10 | | licensed nurse requirement and registered nurse requirement | 11 | | shall not be made effective before January 1, 2014. | 12 | | (Source: P.A. 96-1372, eff. 7-29-10; 96-1504, eff. 1-27-11; | 13 | | 97-689, eff. 6-14-12.) | 14 | | Section 10. The Illinois Public Aid Code is amended by | 15 | | changing Sections 5-5.2 and 5-5.4 as follows:
| 16 | | (305 ILCS 5/5-5.2) (from Ch. 23, par. 5-5.2)
| 17 | | Sec. 5-5.2. Payment.
| 18 | | (a) All nursing facilities that are grouped pursuant to | 19 | | Section
5-5.1 of this Act shall receive the same rate of | 20 | | payment for similar
services.
| 21 | | (b) It shall be a matter of State policy that the Illinois | 22 | | Department
shall utilize a uniform billing cycle throughout the | 23 | | State for the
long-term care providers.
| 24 | | (c) Notwithstanding any other provisions of this Code, the |
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| 1 | | methodologies for reimbursement of nursing services as | 2 | | provided under this Article shall no longer be applicable for | 3 | | bills payable for nursing services rendered on or after a new | 4 | | reimbursement system based on the Resource Utilization Groups | 5 | | (RUGs) has been fully operationalized, which shall take effect | 6 | | for services provided on or after July 1, 2013 January 1, 2014 . | 7 | | (d) A new nursing services reimbursement methodology | 8 | | utilizing RUGs IV 48 grouper model shall be established and may | 9 | | include an Illinois-specific default group, as needed. The new | 10 | | RUGs-based nursing services reimbursement methodology shall be | 11 | | resident-driven, facility-specific, and cost-based. Costs | 12 | | shall be annually rebased and case mix index quarterly updated. | 13 | | The methodology shall include regional wage adjustors based on | 14 | | the Health Service Areas (HSA) groupings in effect on April 30, | 15 | | 2012. The Department shall assign a case mix index to each | 16 | | resident class based on the Centers for Medicare and Medicaid | 17 | | Services staff time measurement study utilizing an index | 18 | | maximization approach. | 19 | | (e) Notwithstanding any other provision of this Code, the | 20 | | Department shall by rule develop a reimbursement methodology | 21 | | reflective of the intensity of care and services requirements | 22 | | of low need residents in the lowest RUG IV groupers and | 23 | | corresponding regulations. | 24 | | (f) Notwithstanding any other provision of this Code, on | 25 | | and after July 1, 2012, reimbursement rates associated with the | 26 | | nursing or support components of the current nursing facility |
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| 1 | | rate methodology shall not increase beyond the level effective | 2 | | May 1, 2011 until a new reimbursement system based on the RUGs | 3 | | IV 48 grouper model has been fully operationalized. | 4 | | (g) Notwithstanding any other provision of this Code, on | 5 | | and after July 1, 2012, for facilities not designated by the | 6 | | Department of Healthcare and Family Services as "Institutions | 7 | | for Mental Disease", rates effective May 1, 2011 shall be | 8 | | adjusted as follows: | 9 | | (1) Individual nursing rates for residents classified | 10 | | in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter | 11 | | ending March 31, 2012 shall be reduced by 10%; | 12 | | (2) Individual nursing rates for residents classified | 13 | | in all other RUG IV groups shall be reduced by 1.0%; | 14 | | (3) Facility rates for the capital and support | 15 | | components shall be reduced by 1.7%. | 16 | | (h) Notwithstanding any other provision of this Code, on | 17 | | and after July 1, 2012, nursing facilities designated by the | 18 | | Department of Healthcare and Family Services as "Institutions | 19 | | for Mental Disease" and "Institutions for Mental Disease" that | 20 | | are facilities licensed under the Specialized Mental Health | 21 | | Rehabilitation Act shall have the nursing, | 22 | | socio-developmental, capital, and support components of their | 23 | | reimbursement rate effective May 1, 2011 reduced in total by | 24 | | 2.7%. | 25 | | (Source: P.A. 96-1530, eff. 2-16-11; 97-689, eff. 6-14-12.)
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| 1 | | (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4) | 2 | | Sec. 5-5.4. Standards of Payment - Department of Healthcare | 3 | | and Family Services.
The Department of Healthcare and Family | 4 | | Services shall develop standards of payment of
nursing facility | 5 | | and ICF/DD services in facilities providing such services
under | 6 | | this Article which:
| 7 | | (1) Provide for the determination of a facility's payment
| 8 | | for nursing facility or ICF/DD services on a prospective basis.
| 9 | | The amount of the payment rate for all nursing facilities | 10 | | certified by the
Department of Public Health under the ID/DD | 11 | | Community Care Act or the Nursing Home Care Act as Intermediate
| 12 | | Care for the Developmentally Disabled facilities, Long Term | 13 | | Care for Under Age
22 facilities, Skilled Nursing facilities, | 14 | | or Intermediate Care facilities
under the
medical assistance | 15 | | program shall be prospectively established annually on the
| 16 | | basis of historical, financial, and statistical data | 17 | | reflecting actual costs
from prior years, which shall be | 18 | | applied to the current rate year and updated
for inflation, | 19 | | except that the capital cost element for newly constructed
| 20 | | facilities shall be based upon projected budgets. The annually | 21 | | established
payment rate shall take effect on July 1 in 1984 | 22 | | and subsequent years. No rate
increase and no
update for | 23 | | inflation shall be provided on or after July 1, 1994 and before
| 24 | | January 1, 2014, unless specifically provided for in this
| 25 | | Section.
The changes made by Public Act 93-841
extending the | 26 | | duration of the prohibition against a rate increase or update |
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| 1 | | for inflation are effective retroactive to July 1, 2004.
| 2 | | For facilities licensed by the Department of Public Health | 3 | | under the Nursing
Home Care Act as Intermediate Care for the | 4 | | Developmentally Disabled facilities
or Long Term Care for Under | 5 | | Age 22 facilities, the rates taking effect on July
1, 1998 | 6 | | shall include an increase of 3%. For facilities licensed by the
| 7 | | Department of Public Health under the Nursing Home Care Act as | 8 | | Skilled Nursing
facilities or Intermediate Care facilities, | 9 | | the rates taking effect on July 1,
1998 shall include an | 10 | | increase of 3% plus $1.10 per resident-day, as defined by
the | 11 | | Department. For facilities licensed by the Department of Public | 12 | | Health under the Nursing Home Care Act as Intermediate Care | 13 | | Facilities for the Developmentally Disabled or Long Term Care | 14 | | for Under Age 22 facilities, the rates taking effect on January | 15 | | 1, 2006 shall include an increase of 3%.
For facilities | 16 | | licensed by the Department of Public Health under the Nursing | 17 | | Home Care Act as Intermediate Care Facilities for the | 18 | | Developmentally Disabled or Long Term Care for Under Age 22 | 19 | | facilities, the rates taking effect on January 1, 2009 shall | 20 | | include an increase sufficient to provide a $0.50 per hour wage | 21 | | increase for non-executive staff. | 22 | | For facilities licensed by the Department of Public Health | 23 | | under the
Nursing Home Care Act as Intermediate Care for the | 24 | | Developmentally Disabled
facilities or Long Term Care for Under | 25 | | Age 22 facilities, the rates taking
effect on July 1, 1999 | 26 | | shall include an increase of 1.6% plus $3.00 per
resident-day, |
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| 1 | | as defined by the Department. For facilities licensed by the
| 2 | | Department of Public Health under the Nursing Home Care Act as | 3 | | Skilled Nursing
facilities or Intermediate Care facilities, | 4 | | the rates taking effect on July 1,
1999 shall include an | 5 | | increase of 1.6% and, for services provided on or after
October | 6 | | 1, 1999, shall be increased by $4.00 per resident-day, as | 7 | | defined by
the Department.
| 8 | | For facilities licensed by the Department of Public Health | 9 | | under the
Nursing Home Care Act as Intermediate Care for the | 10 | | Developmentally Disabled
facilities or Long Term Care for Under | 11 | | Age 22 facilities, the rates taking
effect on July 1, 2000 | 12 | | shall include an increase of 2.5% per resident-day,
as defined | 13 | | by the Department. For facilities licensed by the Department of
| 14 | | Public Health under the Nursing Home Care Act as Skilled | 15 | | Nursing facilities or
Intermediate Care facilities, the rates | 16 | | taking effect on July 1, 2000 shall
include an increase of 2.5% | 17 | | per resident-day, as defined by the Department.
| 18 | | For facilities licensed by the Department of Public Health | 19 | | under the
Nursing Home Care Act as skilled nursing facilities | 20 | | or intermediate care
facilities, a new payment methodology must | 21 | | be implemented for the nursing
component of the rate effective | 22 | | July 1, 2003. The Department of Public Aid
(now Healthcare and | 23 | | Family Services) shall develop the new payment methodology | 24 | | using the Minimum Data Set
(MDS) as the instrument to collect | 25 | | information concerning nursing home
resident condition | 26 | | necessary to compute the rate. The Department
shall develop the |
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| 1 | | new payment methodology to meet the unique needs of
Illinois | 2 | | nursing home residents while remaining subject to the | 3 | | appropriations
provided by the General Assembly.
A transition | 4 | | period from the payment methodology in effect on June 30, 2003
| 5 | | to the payment methodology in effect on July 1, 2003 shall be | 6 | | provided for a
period not exceeding 3 years and 184 days after | 7 | | implementation of the new payment
methodology as follows:
| 8 | | (A) For a facility that would receive a lower
nursing | 9 | | component rate per patient day under the new system than | 10 | | the facility
received
effective on the date immediately | 11 | | preceding the date that the Department
implements the new | 12 | | payment methodology, the nursing component rate per | 13 | | patient
day for the facility
shall be held at
the level in | 14 | | effect on the date immediately preceding the date that the
| 15 | | Department implements the new payment methodology until a | 16 | | higher nursing
component rate of
reimbursement is achieved | 17 | | by that
facility.
| 18 | | (B) For a facility that would receive a higher nursing | 19 | | component rate per
patient day under the payment | 20 | | methodology in effect on July 1, 2003 than the
facility | 21 | | received effective on the date immediately preceding the | 22 | | date that the
Department implements the new payment | 23 | | methodology, the nursing component rate
per patient day for | 24 | | the facility shall be adjusted.
| 25 | | (C) Notwithstanding paragraphs (A) and (B), the | 26 | | nursing component rate per
patient day for the facility |
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| 1 | | shall be adjusted subject to appropriations
provided by the | 2 | | General Assembly.
| 3 | | For facilities licensed by the Department of Public Health | 4 | | under the
Nursing Home Care Act as Intermediate Care for the | 5 | | Developmentally Disabled
facilities or Long Term Care for Under | 6 | | Age 22 facilities, the rates taking
effect on March 1, 2001 | 7 | | shall include a statewide increase of 7.85%, as
defined by the | 8 | | Department.
| 9 | | Notwithstanding any other provision of this Section, for | 10 | | facilities licensed by the Department of Public Health under | 11 | | the
Nursing Home Care Act as skilled nursing facilities or | 12 | | intermediate care
facilities, except facilities participating | 13 | | in the Department's demonstration program pursuant to the | 14 | | provisions of Title 77, Part 300, Subpart T of the Illinois | 15 | | Administrative Code, the numerator of the ratio used by the | 16 | | Department of Healthcare and Family Services to compute the | 17 | | rate payable under this Section using the Minimum Data Set | 18 | | (MDS) methodology shall incorporate the following annual | 19 | | amounts as the additional funds appropriated to the Department | 20 | | specifically to pay for rates based on the MDS nursing | 21 | | component methodology in excess of the funding in effect on | 22 | | December 31, 2006: | 23 | | (i) For rates taking effect January 1, 2007, | 24 | | $60,000,000. | 25 | | (ii) For rates taking effect January 1, 2008, | 26 | | $110,000,000. |
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| 1 | | (iii) For rates taking effect January 1, 2009, | 2 | | $194,000,000. | 3 | | (iv) For rates taking effect April 1, 2011, or the | 4 | | first day of the month that begins at least 45 days after | 5 | | the effective date of this amendatory Act of the 96th | 6 | | General Assembly, $416,500,000 or an amount as may be | 7 | | necessary to complete the transition to the MDS methodology | 8 | | for the nursing component of the rate. Increased payments | 9 | | under this item (iv) are not due and payable, however, | 10 | | until (i) the methodologies described in this paragraph are | 11 | | approved by the federal government in an appropriate State | 12 | | Plan amendment and (ii) the assessment imposed by Section | 13 | | 5B-2 of this Code is determined to be a permissible tax | 14 | | under Title XIX of the Social Security Act. | 15 | | Notwithstanding any other provision of this Section, for | 16 | | facilities licensed by the Department of Public Health under | 17 | | the Nursing Home Care Act as skilled nursing facilities or | 18 | | intermediate care facilities, the support component of the | 19 | | rates taking effect on January 1, 2008 shall be computed using | 20 | | the most recent cost reports on file with the Department of | 21 | | Healthcare and Family Services no later than April 1, 2005, | 22 | | updated for inflation to January 1, 2006. | 23 | | For facilities licensed by the Department of Public Health | 24 | | under the
Nursing Home Care Act as Intermediate Care for the | 25 | | Developmentally Disabled
facilities or Long Term Care for Under | 26 | | Age 22 facilities, the rates taking
effect on April 1, 2002 |
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| 1 | | shall include a statewide increase of 2.0%, as
defined by the | 2 | | Department.
This increase terminates on July 1, 2002;
beginning | 3 | | July 1, 2002 these rates are reduced to the level of the rates
| 4 | | in effect on March 31, 2002, as defined by the Department.
| 5 | | For facilities licensed by the Department of Public Health | 6 | | under the
Nursing Home Care Act as skilled nursing facilities | 7 | | or intermediate care
facilities, the rates taking effect on | 8 | | July 1, 2001 shall be computed using the most recent cost | 9 | | reports
on file with the Department of Public Aid no later than | 10 | | April 1, 2000,
updated for inflation to January 1, 2001. For | 11 | | rates effective July 1, 2001
only, rates shall be the greater | 12 | | of the rate computed for July 1, 2001
or the rate effective on | 13 | | June 30, 2001.
| 14 | | Notwithstanding any other provision of this Section, for | 15 | | facilities
licensed by the Department of Public Health under | 16 | | the Nursing Home Care Act
as skilled nursing facilities or | 17 | | intermediate care facilities, the Illinois
Department shall | 18 | | determine by rule the rates taking effect on July 1, 2002,
| 19 | | which shall be 5.9% less than the rates in effect on June 30, | 20 | | 2002.
| 21 | | Notwithstanding any other provision of this Section, for | 22 | | facilities
licensed by the Department of Public Health under | 23 | | the Nursing Home Care Act as
skilled nursing
facilities or | 24 | | intermediate care facilities, if the payment methodologies | 25 | | required under Section 5A-12 and the waiver granted under 42 | 26 | | CFR 433.68 are approved by the United States Centers for |
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| 1 | | Medicare and Medicaid Services, the rates taking effect on July | 2 | | 1, 2004 shall be 3.0% greater than the rates in effect on June | 3 | | 30, 2004. These rates shall take
effect only upon approval and
| 4 | | implementation of the payment methodologies required under | 5 | | Section 5A-12.
| 6 | | Notwithstanding any other provisions of this Section, for | 7 | | facilities licensed by the Department of Public Health under | 8 | | the Nursing Home Care Act as skilled nursing facilities or | 9 | | intermediate care facilities, the rates taking effect on | 10 | | January 1, 2005 shall be 3% more than the rates in effect on | 11 | | December 31, 2004.
| 12 | | Notwithstanding any other provision of this Section, for | 13 | | facilities licensed by the Department of Public Health under | 14 | | the Nursing Home Care Act as skilled nursing facilities or | 15 | | intermediate care facilities, effective January 1, 2009, the | 16 | | per diem support component of the rates effective on January 1, | 17 | | 2008, computed using the most recent cost reports on file with | 18 | | the Department of Healthcare and Family Services no later than | 19 | | April 1, 2005, updated for inflation to January 1, 2006, shall | 20 | | be increased to the amount that would have been derived using | 21 | | standard Department of Healthcare and Family Services methods, | 22 | | procedures, and inflators. | 23 | | Notwithstanding any other provisions of this Section, for | 24 | | facilities licensed by the Department of Public Health under | 25 | | the Nursing Home Care Act as intermediate care facilities that | 26 | | are federally defined as Institutions for Mental Disease, or |
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| 1 | | facilities licensed by the Department of Public Health under | 2 | | the Specialized Mental Health Rehabilitation Act, a | 3 | | socio-development component rate equal to 6.6% of the | 4 | | facility's nursing component rate as of January 1, 2006 shall | 5 | | be established and paid effective July 1, 2006. The | 6 | | socio-development component of the rate shall be increased by a | 7 | | factor of 2.53 on the first day of the month that begins at | 8 | | least 45 days after January 11, 2008 (the effective date of | 9 | | Public Act 95-707). As of August 1, 2008, the socio-development | 10 | | component rate shall be equal to 6.6% of the facility's nursing | 11 | | component rate as of January 1, 2006, multiplied by a factor of | 12 | | 3.53. For services provided on or after April 1, 2011, or the | 13 | | first day of the month that begins at least 45 days after the | 14 | | effective date of this amendatory Act of the 96th General | 15 | | Assembly, whichever is later, the Illinois Department may by | 16 | | rule adjust these socio-development component rates, and may | 17 | | use different adjustment methodologies for those facilities | 18 | | participating, and those not participating, in the Illinois | 19 | | Department's demonstration program pursuant to the provisions | 20 | | of Title 77, Part 300, Subpart T of the Illinois Administrative | 21 | | Code, but in no case may such rates be diminished below those | 22 | | in effect on August 1, 2008.
| 23 | | For facilities
licensed
by the
Department of Public Health | 24 | | under the Nursing Home Care Act as Intermediate
Care for
the | 25 | | Developmentally Disabled facilities or as long-term care | 26 | | facilities for
residents under 22 years of age, the rates |
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| 1 | | taking effect on July 1,
2003 shall
include a statewide | 2 | | increase of 4%, as defined by the Department.
| 3 | | For facilities licensed by the Department of Public Health | 4 | | under the
Nursing Home Care Act as Intermediate Care for the | 5 | | Developmentally Disabled
facilities or Long Term Care for Under | 6 | | Age 22 facilities, the rates taking
effect on the first day of | 7 | | the month that begins at least 45 days after the effective date | 8 | | of this amendatory Act of the 95th General Assembly shall | 9 | | include a statewide increase of 2.5%, as
defined by the | 10 | | Department. | 11 | | Notwithstanding any other provision of this Section, for | 12 | | facilities licensed by the Department of Public Health under | 13 | | the Nursing Home Care Act as skilled nursing facilities or | 14 | | intermediate care facilities, effective January 1, 2005, | 15 | | facility rates shall be increased by the difference between (i) | 16 | | a facility's per diem property, liability, and malpractice | 17 | | insurance costs as reported in the cost report filed with the | 18 | | Department of Public Aid and used to establish rates effective | 19 | | July 1, 2001 and (ii) those same costs as reported in the | 20 | | facility's 2002 cost report. These costs shall be passed | 21 | | through to the facility without caps or limitations, except for | 22 | | adjustments required under normal auditing procedures.
| 23 | | Rates established effective each July 1 shall govern | 24 | | payment
for services rendered throughout that fiscal year, | 25 | | except that rates
established on July 1, 1996 shall be | 26 | | increased by 6.8% for services
provided on or after January 1, |
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| 1 | | 1997. Such rates will be based
upon the rates calculated for | 2 | | the year beginning July 1, 1990, and for
subsequent years | 3 | | thereafter until June 30, 2001 shall be based on the
facility | 4 | | cost reports
for the facility fiscal year ending at any point | 5 | | in time during the previous
calendar year, updated to the | 6 | | midpoint of the rate year. The cost report
shall be on file | 7 | | with the Department no later than April 1 of the current
rate | 8 | | year. Should the cost report not be on file by April 1, the | 9 | | Department
shall base the rate on the latest cost report filed | 10 | | by each skilled care
facility and intermediate care facility, | 11 | | updated to the midpoint of the
current rate year. In | 12 | | determining rates for services rendered on and after
July 1, | 13 | | 1985, fixed time shall not be computed at less than zero. The
| 14 | | Department shall not make any alterations of regulations which | 15 | | would reduce
any component of the Medicaid rate to a level | 16 | | below what that component would
have been utilizing in the rate | 17 | | effective on July 1, 1984.
| 18 | | (2) Shall take into account the actual costs incurred by | 19 | | facilities
in providing services for recipients of skilled | 20 | | nursing and intermediate
care services under the medical | 21 | | assistance program.
| 22 | | (3) Shall take into account the medical and psycho-social
| 23 | | characteristics and needs of the patients.
| 24 | | (4) Shall take into account the actual costs incurred by | 25 | | facilities in
meeting licensing and certification standards | 26 | | imposed and prescribed by the
State of Illinois, any of its |
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| 1 | | political subdivisions or municipalities and by
the U.S. | 2 | | Department of Health and Human Services pursuant to Title XIX | 3 | | of the
Social Security Act.
| 4 | | The Department of Healthcare and Family Services
shall | 5 | | develop precise standards for
payments to reimburse nursing | 6 | | facilities for any utilization of
appropriate rehabilitative | 7 | | personnel for the provision of rehabilitative
services which is | 8 | | authorized by federal regulations, including
reimbursement for | 9 | | services provided by qualified therapists or qualified
| 10 | | assistants, and which is in accordance with accepted | 11 | | professional
practices. Reimbursement also may be made for | 12 | | utilization of other
supportive personnel under appropriate | 13 | | supervision.
| 14 | | The Department shall develop enhanced payments to offset | 15 | | the additional costs incurred by a
facility serving exceptional | 16 | | need residents and shall allocate at least $8,000,000 of the | 17 | | funds
collected from the assessment established by Section 5B-2 | 18 | | of this Code for such payments. For
the purpose of this | 19 | | Section, "exceptional needs" means, but need not be limited to, | 20 | | ventilator care, tracheotomy care,
bariatric care, complex | 21 | | wound care, and traumatic brain injury care. The enhanced | 22 | | payments for exceptional need residents under this paragraph | 23 | | are not due and payable, however, until (i) the methodologies | 24 | | described in this paragraph are approved by the federal | 25 | | government in an appropriate State Plan amendment and (ii) the | 26 | | assessment imposed by Section 5B-2 of this Code is determined |
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| 1 | | to be a permissible tax under Title XIX of the Social Security | 2 | | Act. | 3 | | Beginning July 1, 2013, January 1, 2014 the methodologies | 4 | | for reimbursement of nursing facility services as provided | 5 | | under this Section 5-5.4 shall no longer be applicable for | 6 | | services provided on or after July 1, 2013 January 1, 2014 . | 7 | | No payment increase under this Section for the MDS | 8 | | methodology, exceptional care residents, or the | 9 | | socio-development component rate established by Public Act | 10 | | 96-1530 of the 96th General Assembly and funded by the | 11 | | assessment imposed under Section 5B-2 of this Code shall be due | 12 | | and payable until after the Department notifies the long-term | 13 | | care providers, in writing, that the payment methodologies to | 14 | | long-term care providers required under this Section have been | 15 | | approved by the Centers for Medicare and Medicaid Services of | 16 | | the U.S. Department of Health and Human Services and the | 17 | | waivers under 42 CFR 433.68 for the assessment imposed by this | 18 | | Section, if necessary, have been granted by the Centers for | 19 | | Medicare and Medicaid Services of the U.S. Department of Health | 20 | | and Human Services. Upon notification to the Department of | 21 | | approval of the payment methodologies required under this | 22 | | Section and the waivers granted under 42 CFR 433.68, all | 23 | | increased payments otherwise due under this Section prior to | 24 | | the date of notification shall be due and payable within 90 | 25 | | days of the date federal approval is received. | 26 | | On and after July 1, 2012, the Department shall reduce any |
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| 1 | | rate of reimbursement for services or other payments or alter | 2 | | any methodologies authorized by this Code to reduce any rate of | 3 | | reimbursement for services or other payments in accordance with | 4 | | Section 5-5e. | 5 | | (Source: P.A. 96-45, eff. 7-15-09; 96-339, eff. 7-1-10; 96-959, | 6 | | eff. 7-1-10; 96-1000, eff. 7-2-10; 96-1530, eff. 2-16-11; | 7 | | 97-10, eff. 6-14-11; 97-38, eff. 6-28-11; 97-227, eff. 1-1-12; | 8 | | 97-584, eff. 8-26-11; 97-689, eff. 6-14-12; 97-813, eff. | 9 | | 7-13-12.)
| 10 | | Section 99. Effective date. This Act takes effect upon | 11 | | becoming law.".
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